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The Games are nearly over and the politics begin – but who are carers’ parliamentary champions now?

The sun may be shining but make no mistake – the summer is over. This week saw the expected Cabinet shuffle. No surprise to anyone really that Andrew Lansley moved on – his bruising over the Health and Social Care Act meant his time had come. We were taking bets in the office on who his successor might be, but no-one predicted the outcome . Jeremy Hunt, I’m sure he would admit himself, has not at any time in his career been notably visible at the helm of campaigns to improve either health or care.

From Olympics to Health Secretary – a tall order for Jeremy Hunt

He has been brought in to persuade us all that the health reforms are all good and will work a treat. Where I am sitting, what I see now is local health professionals and managers, as well as carers, patients and the organisations which support them, entirely unclear how large chunks of this is going to work. Carers Trust and carers’ organisations have spent years working with PCTs so that they begin to understand carers and the kind of support needed, and much of that may now be lost in the transition from one set of decision makers to another. Or alternatively, we may find that little changes except logos, offices and headed paper, with the huge superstructure of the NHS Commissioning Board providing even more bureaucracy than was there before.

So a tall order indeed. Good luck, Mr Hunt. I think you may need it.

In other reshuffle news, here in carer policy land we’re all a bit sad to see Paul Burstow return to the back benches . He was of course, fully involved with the health reforms I’ve just spent half a blog criticising, so he too will have to reflect in five years’ time whether it was all worth it. However what you can say is that no Health Minister, probably ever, has pushed carers’ issues as far as he has in terms of recognition. We now have a draft Care and Support Bill with carers written all over it – not perfect, but you can’t miss the carer theme. He personally took the initiative to put pressure on PCTs to spend money on carers and was supportive of Carers Trust and our campaigns on this. It hasn’t solved everything, and it was never going to in such a short time, but it has made an impact. We’ll miss his role as government champion for carers. I hope Norman Lamb will take a leaf out of his book, in this respect at least.

And finally, today we have the second reading debate on the Social Care (Local Sufficiency) and Identification of Carers Bill. Barbara Keeley MP – an incredible advocate for carers – has used her Private Members Bill slot to promote the ways in which carers can be supported and increase the duties on a range of organisations to identify carers. Watch this space for an update on the debate early next week. Good luck Barbara, and thank you – we’re all behind you.

The Government has made an immediate response to our ‘NHS Not Making the Break for Carers’ report by prioritising carers in the NHS Operating Framework for 2012/13. The Operating Framework is the set of requests given to the NHS by the Department of Health every year, guiding their priorities.

Following our report, the Government has said that carers is one of only three areas that have been designated as requiring “particular attention”. Think of all the illnesses, diseases, long-term conditions and medical issues the NHS is concerned with, and then consider what it means that carers are up there as the most important priority.

Of course, the reason that the NHS needs to pay “particular attention” is because they have not been doing enough to support carers, despite additional money and Government requests to do so. This Operating Framework is a sign that Health Ministers Paul Burstow and Andrew Lansley are losing their patience having been quite clear what they expected from the NHS in terms of supporting carers.

What they didn’t expect was that most Primary Care Trusts (PCTs – local NHS bodies) would not publish plans and budgets to support carers despite being asked to; and that some would continue not to invest a single pound in services to support carers, despite receiving additional money for this.

So for 2012/13, PCTs need to agree plans and budgets with local authorities and local carers’ charities. These plans should identify how much of the total is being spent on breaks and indicate the number of breaks that should be available from that funding. Importantly, PCTs have to publish these details on their websites by 30th September 2012 at the latest.

But we can’t wait until then to act. Carers and carers’ charities need to be contacting their local PCT now to find out how they will be improving on what they were doing this year. PCTs by ranking in terms of spending on services for carers and ask the non-Executive Directors of your PCT what they will do to improve that.

The NHS has a duty to those people who have often sacrificed so much to care for people, and they also have a duty of care to their patients who are otherwise being cared for by their friends and family. Our message should echo that of the Government’s; the NHS can no longer avoid their duty to carers.

On 1st July, MPs debated how to support carers have a life of their own in Parliament giving us the first opportunity to see Paul Burstow MP and Barbara Keeley MP, Minister and Shadow Minister for Care Services respectively, debate the issue.

Burstow began by highlighting the huge benefit that being in contact with social services can make to carers: a DH survey of 35,000 carers in contact with social services found that only 13% said they did not have the time to do anything they enjoyed whereas a Carers Week survey of 3200 carers, many of whom may not have been in contact with social services, found 76% did not think they had a life outside of caring.

From this the first of his three priorities is for more carers to be identified and for GPs to play a large role in this. His other two are to improve joint working between health, social care, and the voluntary sector, and secondly to extend the use of direct payments/personal budgets.

On cancelling Caring with Confidence (CwC), he advised that the course materials were good but they weren’t getting value for money from delivery. So, he will give the materials freely to Carers’ Centres and other providers of the programme while reinvesting the money in training for GPs on carers’ issues and other support for carers which will be announced soon.

He also advised that the DH would shortly publish an audit of Primary Care Trust support for carers, which is welcome news. Keeley replied that money for carers must be ringfenced as history has proved it is the best way to ensure that money goes where Government (& Parliament) intends… If only her previous colleagues had learnt this lesson.

Keeley expanded on this by arguing that with GPs taking on a larger role in commissioning local services and schools becoming independent of local authorities, it would be even harder to ensure that a strategic view of the needs of carers was taken in every area.

To address this, she plans to reintroduce her Carers ( Identification and Support) Private Members Bill of 2007. This would require health bodies to identify patients who are carers or have a carer and that health services took the carers’ needs into account. It would also have require schools to have a policy to identify young carers.

Responding to the CwC cancellation, Keeley pointed out that there will still be costs of actually running the course and training GPs should come out of NHS core budgets. Tony Baldry MP (Chairman of the All Party Parliamentary Group for Carers) commented that carers will still need to be trained to help manage their caring role. He also asked the Minister to look at the Work & Pensions Select Committee’s report on carers which recommended a costs of caring payment of approximately £25-£50 p/w could be given to all carers in intensive caring roles, even if receiving the State Pension.

Other MPs spoke of the need to increase benefits for carers pointing out that proposed benefit changes will see Carer’s Allowance rise slower than before and potentially fewer carers receiving it due to fewer people they are caring for getting Disability Living Allowance (DLA is requisite for the carer to get Carer’s Allowance). Many spoke of the particular need to support young carers and it was good to hear that so many had visited their local Carers’ Centre and young carers’ services and been impressed by their work.

Waking up from the hangover of England’s World Cup campaign? Here’s what you missed.

Cuts could still happen at the local level

Budget and benefits

All benefits, except pensions, will rise in line with the Consumer Price Index measure of inflation, which excludes most housing costs, rather than Retain Price Index. CPI is usually about 1% lower meaning benefits will rise slower in future.

Paul Burstow MP, Minister for Care Services, advised that no grants for adult social care would be cut in 2010/11. The Carers Grant remains unring-fenced although each local authority has an amount identified within its’ budget as its’ share of the £256m national Carers’ Grant from the Dept of Health. £20m will be reinvested in respite for disabled children from what would have been invested in the now scrapped Child Trust funds for disabled children, and this will be ongoing annually.

However, because these grants are not ring-fenced local authorities could use some of the funds to cover shortfalls in other areas of their funding where there have been cuts. So cuts could still happen at the local level but it would be madness to cut support for carers – see an earlier post. Sir David Nicholson, CEO NHS England, has recognised this whilst saying that the NHS should use its funding to cover shortfalls in social care.

What’s happening with the pledges on carers?

The previous Minister for Care Services, Phil Hope, requested that Strategic Health Authorities scrutinise what PCTs are doing to support carers. The new Minister, Paul Burstow MP, is currently analysing information from SHAs.

encourage the NHS to do more to identify and respond to carers’ needs earlier to prevent ill-health

improve information, advice and support to help carers stay in or get back to work if they are able and willing

refresh the Carers’ Strategy as it only taken partial steps to improve support for carers

However, the recently revised NHS Operating Framework for 2010/11 does not increase carers as a priority for the NHS, but does ask PCTs to publish how they are implementing the Dementia Strategy. Why can’t they do this for the Carers’ Strategy?

So there should be a lot for MPs to talk about during their debate on carers on 1st July. Kick off is 14:30 in Westminster Hall. Let’s hope there’s something to cheer about.

As part of Carers Week, we held an event for new MPs to meet carers. It was set up like speed dating with a couple of carers at each table and the MPs moving around each table after five to ten minutes talking and listening to the carers.

What struck me was that the issues that carers were talking about were not things that MPs or even national government have responsibility for. In contrast, new MPs may arrive at Parliament relishing the opportunity to radically improve things by passing laws or contribute to grand plans. And yet, it seems to be the details that are dealt with at a local level that are what people want focus on.

Carers need children and adult services to work better together. They need local commissioning of support services such as training, emotional support and breaks. They need cooperation between local authorities and hospitals to improve discharge processes. They need health and social professionals to listen to them.

National Government can and have produced guidance on these issues but responsibility for carrying them out is at the local or even individual level.

We saw the powerlessness of MPs when many lobbied their local PCT to spend the Carers’ Strategy money. But despite the Prime Minister announcing the money was to double respite care; despite Government Ministers stating that they wanted PCTs to use the full allocation on carers; and despite MPs writing letters and meeting PCT Chief Executives, many PCTs still decided to use the money elsewhere.

The trend is towards local decision making so the focus on national MPs may become ever more misplaced. May 6th was an important day – there were approximately 9000 councillors elected.

It was good to hear Paul Burstow MP (Minister for Care Services) say in Parliament yesterday that he would never lose sight of carers, but it’s councillors and local health and social care professionals that have the power to change carers’ lives for the better. They don’t need to wait for new legislation or national government, they can make the changes now.

Thirteen days and twelve hours after the polls closed, now we know. The new Government’s programme – an amalgamation of manifestos – has been published. You’ve got to hope that those who stayed up during election night didn’t wait this long before catching some sleep.

The big worry was that there would be no reform of social care in England. But the good-as-could-hope-for news is that a(nother) commission will report within one year on ideas including a voluntary insurance scheme to protect assets of those in residential care (Tory policy) and a partnership scheme proposed in the Wanless Review (Lib Dem policy).

People receiving support and carers must be a part of this commission.

For carers specifically, the new Government has said they will use direct payments to carers and better community based provision to improve access to respite care. We’ve heard on the grapevine that the new Health team (Andrew Lansley MP is Secretary of State and Paul Burstow MP is Minister for Care Services) are keen to address PCTs not using the Carers’ Strategy money for carers. We hope to work with them on this.

And the Government are proposing elections for part of the Primary Care Trust boards. Carers – get in there!!

Other announcements include:

Help elderly people live at home using community support programmes and adaptations

Restoration of earnings link for the basic state pension from April 2011 and will rise by the higher of average earnings, prices or 2.5%.

So this is the good news. The bad news, that we must all expect, will be the £6bn savings to be announced in a new budget promised within 50 days of taking office. But that’s only for this financial year. April 1st 2011 is the date that many local authorities dread, which I’ll explain about more in a later blog.

HRH THe Princess Royal joined MPs from the three main parties at the roundtable event

You cannot change the quality of care in this country without respecting carers and improving the support they receive. This was the simple message delivered to the three political parties at yesterday’s conference on carers. The response we were seeking was what each party would pledge to do for carers in the next Parliament…

Care Services Minister Phil Hope focussed more on what the Government had done in this Parliament to increase support for carers, and there have been improvements: £25m training and employment support for carers; recent £1m investment in young carers’ services; new credit scheme to help carers build up pensions; and a national helpline and website for carers.

But the big moment came when he put himself on the line in response to our report “No Breaks for Carers” on PCTs not supporting carers – “I will personally hold PCTs to account for the carers’ money they will receive but do not spend on carers and will keep going until they do spend the money on carers” (read the full story here).

It’s not often that politicians make a personal pledge like this. Eyes darted around the room to see reactions.

Shadow Health Minister Stephen O’Brien did not give detail but pinpointed two issues that he wants to tackle: carers losing Carer’s Allowance when earning over £100p/w and when they begin receiving a State Pension. O’Brien restated that the Conservatives would retain Attendance Allowance and Disability Living Allowance and that indeed his parent’s in law rely on AA. He also said that the Conservatives would announce a policy to improve care in the home to accompany their residential care policy, and that they wanted to extend flexible working for carers.

Under Lib Dem plans carers would be able to receive a personal budget and choose what to spend it on

Liberal Democrat Chief Whip Paul Burstow expanded on his party’s pledge to commit £500m p/a to carers. Carers would be able to receive a personal budget, for example of £510, and could choose what to spend it on. Lib Dems would act upon the Work & Pensions Commons Select Committee report (August 2008) which recommended increasing Carer’s Allowance.

Burstow also agreed with a carer who spoke later that carers must be a higher priority for the NHS – not a Tier 3 lowest priority giving the NHS the option to support carers or not; carers have to be a “must do” for the NHS. He finished by praising his local Sutton Carers’ Centre which he said had “educated him” about wide range of carers’ needs and issues.

Two carers spoke and gave their recommendations which included making GPs improve their identification of carers, and the RCGP representative agreed they would continue to raise the profile of carers amongst GPs. Tory MP carers campaigner in Parliament, Tony Baldry, suggested that a voluntary register of carers would prompt all professionals to ask if people had caring roles and then people could have an annual review to ensure they were receiving support.

What found universal agreement was an approach that saw everybody in health and social care informing, advising and supporting carers as part of their role. This responsibility cannot be passed to a few appointed individuals within organisations or there will still be too many carers ignored, isolated and in danger of failing health themselves.

We presented questions from carers, including a one asking the MPs if they would like to be a carer for the day. The MPs declined, which goes to show how much harder we have to work to improve the lives of carers.